Post-Exposure Treatment of HIV – Taking Some Risks for Safety’s Sake

Author(s): David K. Henderson MD
Journal: The New England Journal of Medicine
Month, Year: November 2007
Major topic: HIV exposure management
Type of Article: Editorial
Findings: The occupational infection and eventual death of a health care worker in 1988 was controversial and led to a variety of post exposure protocols. These included increased education about HIV, safety measures like plastic coated test tubes and the investigation and eventual implementation of a chemoprophylaxis with nucleoside analogue zidovudine secondary to exposure. Education and informed consents were given before beginning the course. This course has some scientific evidence but it was mainly done so that the hospital would be seen as a worker advocate. The workers were told about the mutagenic and teratogenic risk but it still was scrutinized in the media and scientific literature. Current literature and experiences support the earlier decision, although the course has been modified to include antiretrovirals and other nucleoside analogues. Risk factors have also been elucidated as part of a 1995 study; a deep injury, injury with a device visibly contaminated with blood from the source patient, a procedure involving a needle placed in the source patient’s artery or vein and exposure to a source patient who dies of AIDS within 2 months. Post exposure chemoprophylaxis with zidovudine was associated with a reduction in risk of transmission by 81%, although the study was performed under non-ideal conditions. While the efficacy and risk of administering chemoprophylactic drugs, most people have found the fear of infection outweighs the inherent risks of prophylactic treatment.
Key points/Summary: While the efficacy and safety of chemoprophylactic treatment has not been absolutely determined, it is still often used at the very least to offset the fear and trepidation secondary to occupational exposure.
Assessment of article: An editorial but well written and good information to have on hand particularly if a member of your staff is exposed.


Brian Schmid DMD